Date of Award

4-26-2019

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Christine P. Kurtz

Abstract

Intrauterine device (IUD) insertions and endometrial biopsies (EMB) can be painful in office gynecological procedures. In the clinical setting used for this evidence-based project (EBP) it was noted there was no consistent pain management being used for these procedures. For this EBP project a protocol for pain management during IUD insertions and EMBs was developed and implemented into this clinical setting. The protocol was created from an exhaustive literature search, which yielded six pieces of high-level evidence of good quality. The evidence supported the use of a 1% lidocaine paracervical block prior to IUD insertion and a 2% lidocaine intrauterine infusion prior to EMB. The sample included women age 18 and older receiving an IUD insertion or EMB. Pain scores were collected on 7 EMBs and 13 IUD insertions who did not receive the intervention. Pain scores were collected on 5 EMBs and 7 IUD insertions who received the intervention. Pain scores were recorded using the numeric pain rating scale. The non-intervention group and the intervention group contained different participants in each group. Because the groups contained different participants, the pains scores were analyzed using an independent t-test. Patients receiving the intervention for EMBs had statistically significantly lower pain scores compared to the non-intervention group for EMBs (t(10)=2.759, p <.05). There was no statistical significance in the intervention group for IUD insertions compared to the non-intervention group for IUD insertions (t(18)=1.826, p >.05). This EBP project was easily implemented as patients were very willing to participate, most providers were willing to participate, lidocaine was relatively inexpensive, and only about 5 minutes of extra time was added to each procedure. Application would include using the intrauterine infusion prior to EMBs in practice and future research in pain management while stratifying nulliparous and multiparous participants for IUD insertions and EMBs.

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